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SMALL ANIMAL
The latest on
exotic worms
page 26
THE UK’S LEADING MONTHLY VETERINARY PUBLICATION MARCH 2019 OFFICIAL VET
Deal or no deal,
transferring
animals will
change
page 43
LARGE ANIMAL
Reviewing bovine
TB control in
Devon
page 46
EQUINE
Was the
outbreak of
equine influenza
a dress rehearsal
for something
more serious?
Dermatology
page 52
PRACTICE MANAGEMENT
Improving management with
immunotherapy To finance or not
to finance?
page 58
Plus
INNOVATION Could a new app spark change in the veterinary market? / MENTAL HEALTH M Facebook.com/vetpracticeonline
Taking the ups with the downs / DENTISTRY What dangers lie within your dental units?
EQUINE Epididymal semen harvesting / PRACTICE MANAGEMENT Monitoring radon levels
N @VetPractice_Mag
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very concerned that alternative methods have not chosen to
neutering could to surgical surgically castrate
be harmful for castration2 because it is
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1. Mo Gannon & Associates (2017). Do you think neutering is harmful for dogs?. MG&A.
2. Harris interactive. Understanding the usages & attitudes around cats & dogs sterilization and evaluating the potential of Suprelorin. (2017).
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EDITOR’S WELCOME
“Find out how technology could
be set to change the way the
veterinary market works”
S
tunning before slaughter is in Find out how technology could be set to
the headlines again this month; change the way the veterinary market
results of the Food Standards works in a fascinating interview with
Agency’s 2018 slaughterhouse survey the co-founders of a new app in our
have been released, revealing that 94 innovation column this month.
million cattle, sheep and poultry were Ian Wright provides an update on
slaughtered without being stunned exotic worms in the small animal
first, and that there is uncertainty over section, and Bob Partridge explains the
where a proportion of this non-stunned dangers of dental units for the health of
meat is sent. In response, the BVA and those working with them.
RSPCA are calling for change. Read the Dermatology is in focus this month;
full story in the news section. Anita Patel describes the benefits of
Elsewhere, veterinary preparations immunotherapy in the management
are underway for a no-deal Brexit; the of canine atopic dermatitis and our Treating diarrhoea is discussed in
RCVS Council has approved a path- regular columnist David Grant offers an equine, and we have an interesting
way for paraprofessionals to become in-depth look at the treatment of canine piece detailing the processes involved
accredited and free certification training juvenile onset generalised demodicosis. in epididymal semen extraction.
is now available to vets. We have two In large animal, Richard Gard reports The details of offering clients credit
interesting Brexit-based articles this on the 2019 Western Counties Veteri- options, the importance of monitoring
issue: the first on the potential impact nary Association meeting; the discus- radon levels and management tips for
on animal welfare and the second in the sion generated lots of attention thanks large animal practices can all be found
OV column, which looks at the effects to the involvement of many different in the practice management section.
on transport of animals around the EU. TB stakeholders, including TB activist
There is lots of news for OVs to catch Brian May. Also turn to this section for
up with, with many changes to OV train- the second piece in John Fletcher’s
ing underway and further information series on farmed deer, which this
regarding potential changes to practice month covers the diseases commonly
in the case of a no-deal Brexit. seen, and how to deal with them. JENNIFER PARKER EDITOR
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12:09 1
CONTENTS
IN FOCUS
34 Improving management with immunotherapy
What are the benefits of allergen-specific immunotherapy
in the management of canine atopic dermatitis?
36 Treating canine juvenile onset generalised
demodicosis
A guide to the well-known demodicosis which can
present in several forms and seems to be on the rise
in the UK.
39 A look through the latest literature
The latest academic publications providing further insight
into this month’s “In focus” topic.
REGULARS SMALL ANIMAL
4 News 26 Parasites
A snapshot of the topics currently hitting industry Four exotic worms you’re likely to see in your
headlines. practice in 2019 and how to deal with them.
12 Events 30 Dentistry
Read a report from the SPVS/VMG Congress and Harmful biofilms found within veterinary dental
find out what delegates can most look forward to units could be a health hazard to veterinary
at the 2019 BSAVA Congress. professionals.
20 Innovation
OFFICIAL VET
The introduction of a first-of-its-kind veterinary
app for cat and dog owners may disrupt practice
40 News and updates
as we know it.
The latest news and updates for OVs.
22 RCVS Knowledge
Blocking the pain of castration in cats and dogs. 43 Deal or no deal, transferring animals will
change
24 Mental health What impact will Brexit have on the movement of
Could we change our mindsets to enjoy the paddle animals to and from EU countries?
to sea as well as the surf back to shore?
44 Antimicrobial resistance in pig production
25 Animal welfare Coordinated, rapid responses could be required
Would a no-deal Brexit lead to compromised welfare on a global scale to tackle emerging antimicrobial
standards? resistance threats.
EDITORIAL ADVERTISING ENQUIRIES HEAD OFFICE
Nic Catterall 5m Publishing, Unit 10, Southill Business
MANAGING EDITOR 07730 762136 Park, Cornbury Park, Charlbury OX7 3EW
Ellen Hardy nic.catterall@5mpublishing.com
© 5m Publishing Ltd (2018): no part of
EDITOR Sally Pye this publication may be reproduced in any
Jennifer Parker 07867 357553 form (except for review purposes) without
Veterinary Practice (ISSN: 0042-4897) is an independent sally.pye@5mpublishing.com the express permission of the editor.
monthly publication, free to members of the veterinary DESIGN
profession in the UK. It is available on subscription: UK
is £40 per year, Europe is £90 per year and the rest of
5m Publishing
PRINTING
EDITORIAL ENQUIRIES
Jennifer Parker
M Facebook.com/vetpracticeonline
the world is £120 per year.
Volume 51, number 2 Buxton Press
07879 998719
jennifer.parker@5mpublishing.com N @VetPractice_Mag
2
LARGE ANIMAL 62 Tackling the management challenges of
large animal practice
46 Reviewing bovine TB control in Devon At the 2019 SPVS/VMG Congress, the owner of an
award-winning farm animal practice explained how
Views on control methods were exchanged in a
she keeps her team happy.
meeting attended by vet Dick Sibley, TB activist
Brian May and a range of professionals involved
63 VDS training
with TB control.
How you can get the most out of each
48 Diseases of farmed deer consultation.
Learn about managing disease in the second article
of a two-part series on deer farming in the UK. OPINION
51 David Williams
EQUINE “Maybe more personal support on a daily basis is
the key to keeping people happy”
52 Lessons from the influenza outbreak
Was the outbreak of equine “flu” a dress rehearsal 64 Gareth Cross
for something more serious? “You can’t de-tune your mind to pick up on
adversity, so complaints will still
53 Treating diarrhoea cases disproportionately affect us”
Treatment of diarrhoea in the adult horse is
considered in part two of the series on equine
diarrhoea.
56 Epididymal semen harvesting
Is your
Post-castration epididymal sperm extraction is
a pioneering method of semen collection that
permits semen extraction where other options
subscription
don’t allow.
PRACTICE MANAGEMENT
58 To finance or not to finance? information
up to date?
Key legal and compliance considerations for
practices planning to offer credit options to clients.
61 Monitoring radon levels Email michael@teamworkprofessionals.co.uk
Do you need to identify and manage radon within to update our records
your practice?
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Veterinary Practice | March 2019 3
NEWS
Is it time to end non-stun slaughter
in the UK?
On 14 February, the BVA responded to the Food Standards
Agency (FSA) 2018 slaughterhouse survey, which has finally
been released following pressure from the BVA and others
to make the data public.
The survey, which provides a comprehensive snapshot of
slaughter methods by species in England and Wales, had
been expected for publication by autumn 2018. Following
campaigning activity by the BVA and the RSPCA, as well
as a parliamentary question from Kerry McCarthy MP, the
government agreed to release the figures following consul-
tation with religious groups.
Figures reveal that in 2018, over 94 million cattle, sheep
and poultry were slaughtered without being stunned first.
Specifically, the figures show that nearly a quarter (24 per-
cent) of sheep meat that was not stunned before slaughter
was exported from the UK. This equates to around 750,000
sheep being slaughtered without prior stunning per year for
consumption outside of the domestic market. The current
derogation in the law that allows for non-stun slaughter for
religious purposes is intended for domestic consumption only.
Although most of this meat is intended for EU markets ρρ An immediate post-cut stun for cattle, sheep, goats and
including France, Belgium and the Netherlands, with deer to reduce the period of pain and distress
post-Brexit trade deals currently in discussion, it brings into
question where the remaining non-stun meat is sent. The The letter follows a recent, high profile decision to ban the
survey also reveals a lack of transparency with regards to slaughter of animals without prior stunning in the Flanders
some exports. For example, 19 percent of sheep meat was region of Belgium, which came into force at the start of
recorded as destined for “unknown” locations. This lack of the year. Belgium joins several other European countries,
information was referenced within the survey as being due to including Iceland, Sweden, Switzerland and Denmark, in
non-mandatory questions being left incomplete by abattoirs. making this decision, demonstrating that a full ban on non-
The RSPCA and the BVA have joined forces to call on the stun slaughter is possible within EU law.
UK government to repeal a legal exemption that permits BVA President Simon Doherty said: “The UK government
animals to be slaughtered without pre-stunning, causing has repeatedly stated it would prefer to see all animals
unnecessary pain and suffering. stunned before slaughter but has taken no action to
In an open letter to Environment Secretary Michael Gove, address this critical welfare issue that affects millions of
the BVA and the RSPCA have urged the UK government to animals every year.
change legislation in England, which currently allows non- “There is a huge groundswell of support for a ban on
stun slaughter for religious purposes. non-stun slaughter, and recent developments in Belgium
show that decisive change is possible where public support
Until such legislation is in place, the RSPCA and the BVA is matched by political will. Michael Gove has made clear
are calling for: that he wants to maintain and build on the UK’s reputa-
tion as global leader on animal welfare; banning non-stun
ρρ Meat to be labelled with the method of slaughter, eg slaughter is a sure-fire way of showing he will deliver on
stunned or non-stunned, so consumers are fully this commitment.
informed about the meat that they are buying “If slaughter without stunning continues to be permitted
ρρ Non-stun slaughter to only be permitted at levels in the UK, then meat and fish from this source must be
that meet local religious community demand for this clearly labelled, to help customers make informed choices
type of meat in the interests of limiting animal pain about the food that they buy and eat.”
and suffering
Sign the open letter at: rspca.org.uk/endnonstun and
ρρ A ban on export of meat from non-stunned animals or
join the online debate using the hashtag #EndNonStun
live animals destined for non-stun slaughter
4
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Veterinary Practice | March 2019 5
RCVS to recognise
quality-assured European
veterinary degrees
On 6 February, the House of Lords passed a Statutory Instru-
ment (SI) to allow the RCVS to continue to register veterinary
surgeons from the EEA after the UK leaves the EU.
The Veterinary Surgeons and Animal Welfare (Amendment)
(EU Exit) Regulations 2019 were debated in the House of
Lords after being introduced by Lord Gardiner of Kimble,
Parliamentary Under Secretary of State for Rural Affairs and
Biosecurity at Defra.
The key part of the amendment was that the RCVS would,
after Brexit, be able to introduce the Statutory Examination
for Membership for EEA and Swiss nationals where they hold
a degree that does not meet RCVS educational requirements
and standards. Under the existing Mutual Recognition of
Professional Qualifications Directive, EEA and Swiss nationals
SPEED, FLEXIBILTY AND QUALITY with a veterinary degree from these areas can join the Regis-
ter without any additional assessment being made. Currently,
the Statutory Examination for Membership is only undertak-
en by prospective registrants from outside the EEA who hold
a qualification that the RCVS does not recognise.
On the same day, the RCVS Veterinary Nurses Council
Choice
The right
agreed changes to how it registers veterinary nurses who
qualified in the EEA should the UK depart the EU without a
deal. The changes are in line with new regulations drawn
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MUSICA empowered – No compromise on image quality Sports Editor Nick Powell, will ask if we can meet the welfare
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Veterinary Practice | March 2019 7
NEWS
Free certification training New scheme launched to
in Brexit preparations tackle brachycephaly
The BVA has warmly welcomed plans to offer free certifica- Developed by the University of Cambridge and funded by the
tion training for vets to help meet increased demand for this Kennel Club Charitable Trust, the new Respiratory Function
service in the event of a no-deal Brexit. Grading Scheme assesses dogs for the presence and sever-
Under the new plans, announced on 8 February 2019 by ity of Brachycephalic Obstructive Airway Syndrome (BOAS).
the APHA, vets will be able to access Official Control Qual- The scheme is currently available for flat-faced breeds and
ification (Veterinary) (OCQ(V)) training in the qualifications has the potential to improve the health and welfare of these
required to certify the export of animal products to the EU. breeds for generations to come. The assessment, which can
The APHA is rolling out the training in recognition of a now be carried out by a number of specially trained asses-
potential surge in demand for veterinary certification of ani- sors located across the UK, involves listening to the dog’s
mal products for export in the event of a no-deal Brexit. airway both before and after an exercise tolerance test.
Official Veterinarians who are already registered on the Assessors, who are all specially trained BOAS vets, then
database but do not hold a products exports qualification use a predefined protocol to grade the dog from zero to
(OCQ(V) - PX) will be able to access free training in the three. The scheme issues guidance that dogs graded three
Essential Skills and Exports General modules: courses should not be bred from.
which need to be completed ahead of gaining the full For Kennel Club registered dogs, these grades will be
qualification. Vets who are not OVs but who wish to offer recorded on the Kennel Club’s database and published in
certification services can receive registration with Improve the Breed Records Supplement, on the dog’s registration
International’s database and train in all three required certificate and on the Kennel Club Health Test Results Finder
qualifications free of charge. and Health webpages. The BOAS scheme will be supported
Simon Doherty, BVA President, said: “A no-deal Brexit could by guidelines for breeders, which enable them to understand
see the requirement for veterinary certification services the grade for their
spiralling, so it makes sense to prepare ahead to ensure that dogs in terms of risk For more details on the scheme,
there is adequate supply of suitably qualified vets to meet when considering visit: thekennelclub.org.uk/rfgs
this demand in case no agreement is reached.” potential matings.
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Veterinary Practice | March 2019 9
For more information, visit www.credelio.co.ukNEWS
RCVS Council opens the path for
paraprofessionals
The RCVS Council has approved a pathway for veterinary directly responsible for the register of any individuals
and animal health paraprofessionals to become associates undertaking such minor acts of veterinary surgery.
of or accredited by the college, and therefore fall within the Council members also confirmed that two paraprofes-
RCVS regulatory remit. sional groups that have already expressed an interest in
At the June 2017 meeting of RCVS Council, members being regulated by the college – meat inspectors and
decided to look into two separate models by which para- animal behaviourists – will now be invited by the college
professionals working in the veterinary, animal health to apply for associate or accredited status.
or related fields might be regulated by the college in the The RCVS is also in communication with a number of
future under powers granted by the RCVS’s new Royal other paraprofessional groups, including those represent-
Charter in 2015. ing animal musculoskeletal practitioners and equine dental
The first was an “accreditation model”, which would technicians, about the future of paraprofessional regulation.
involve the RCVS accrediting an organisation which would However, the RCVS Legislation Working Party (LWP) and
regulate the profession in question; the second was an RCVS Council agreed that, before such professions could
“associate/full regulation” model, in which individual become associates, there would need to be reform of the
paraprofessionals would receive a similar level of regula- Veterinary Surgeons Act in order to remedy some of the
tion to that already received by veterinary surgeons and deficiencies of the current legislative regime and make sure
veterinary nurses. that these groups have appropriate legal underpinning for
As part of its legislation review, the college met with their work.
numerous paraprofessional organisations and further con- This complements the ongoing discussions on changes to
sidered the two different models before making its recom- the legislative framework to bolster the role of veterinary
mendations to RCVS Council. At its January 2019 meeting, nurses. Defra has been asked to consider these specific
the RCVS Council agreed to proceed with both proposed changes to the legislative framework along with its wider
models of paraprofessional regulation (the associate and review of improving the legislative underpinning of the
accreditation models), with the suitability of each model veterinary professions.
being considered on a case-by-case basis, depending on the One particular issue concerns equine dental procedures,
nature of the profession applying for recognition. which are often carried out by well-trained paraprofession-
Paraprofessionals whose work will need to be under- als but without supporting legislation or regulation. The
pinned by Schedule 3 reform would need to apply for the RCVS proposals are designed to remedy these deficiencies
associate model, as the RCVS would be required to be by providing a framework for these activities.
Anderson Moores and the RVC ask for support in
vital Alabama rot research
Anderson Moores Veterinary Specialists and the RVC, performed free of charge to confirm the diagnosis. In con-
along with Bayer Animal Health, are asking vets across the firmed cases the veterinarian will then be sent a link to a
country to report suspected cases of cutaneous and renal 10-minute survey to be completed by the owner. Along with
glomerular vasculopathy (CRGV), or Alabama rot. encouraging the owner of the confirmed case to take part,
The disease has been increasingly discussed within the four unaffected control cases from the same clinic, on the
veterinary profession. However, many vets may not be same day, will also need to be recruited.
aware that prevalence of the disease has been steadily When a set of five qualifying surveys (one confirmed case
increasing across all regions of the UK. In a bid to gain and four control cases) are provided, practices can claim
vital insight into CRGV and what may be causing it, an Amazon Echo Dot, provided by Bayer as a thank you for
researchers are asking for information on cases seen helping with this research.
in practice.
Vets are being asked to contact Anderson Moores with If you have a suspected case, contact Anderson Moores
any suspected cases of CRGV. If the pet does not sur- on: 01962 767920 or email:
vive, then histopathologic assessment of tissue will be medicine@andersonmoores.com
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Veterinary Practice | March 2019 11EVENTS
Why are so many vets unhappy?
Caroline Clarke explained the results of and pragmatic protocols,
together with the life and
her research into the profession at the death consequences of fail-
2019 SPVS/VMG Congress ure, they feel more troubled
by these outcomes.”
P
ractice will never make perfect for those veterinary Vets should stop feeling
surgeons who believe the hype about their profes- individually responsible
sion’s omniscience, a leading sociologist has warned. for every failure that occurs
Caroline Clarke, senior lecturer in organisational studies at in practice, Caroline sug-
the Open University, explored the reasons why many vets are gested. This requires inter-
unhappy with their career choice in her presentation at the ventions at three different
Society of Practising Veterinary Surgeons/Veterinary Man- levels – in the vet schools,
agement Group conference in Newport on 25 January 2019. in the national veterinary
Her research has shown that new graduates enter the bodies and within each
profession with unreasonable expectations and the result- practice.
ing disappointment does much to explain the heavy toll of During the undergrad-
mental health problems among practitioners – and why up uate course, vet students
to 50 percent have considered leaving the profession within need to learn the limita-
five years of qualifying, she suggests. tions of the scientific method and that they should abandon
Working with David Knights from the University of Lan- their quest for perfection, which is based on “erroneous
caster, Caroline interviewed 78 clinicians from all branches beliefs that uncertainty can be eradicated”, she said. Their
of veterinary practice and at various stages of their car- teachers should also be prepared to admit that in a large
eers. Their findings were published last year in the paper proportion of patients seen in routine practice, treatment is
“Practice makes perfect: Skillful performances in veterinary not a matter of life or death – “80 percent of them will get
work” in the journal Human Relations. better despite what you do to them.”
Many of the comments made by practitioners about their Caroline acknowledged that vets are not alone in experi-
career choice showed them to be plagued by self-doubt. encing professional failures like the death of a patient. But
While this may be more common in younger clinicians, some features of their practice set vets apart. Veterinary
these anxieties are never fully resolved for many experi- practitioners are working for a private business subject to
enced colleagues. Caroline quoted an anonymous practi- strong commercial pressures and they will often carry out
tioner’s poignant admission on the Vet Confessions website. their duties on their own without the advice and encourage-
“It’s a career I’ve mostly hated, convinced that if I just ment of professional colleagues, she pointed out.
worked harder, learned more, specialised … there would One of the most striking findings from more than 100
come a point at which I would suddenly start enjoying the hours of interviews with veterinary practitioners was that
job, or at least find it bearable. That point has never come no one was ever sure whether they were doing a good job.
and I now know it never will.” She urged all practices to introduce a system for regular
Caroline argued that this dissatisfaction results from appraisals that would give encouragement to those with
vets’ struggles to cope with the conflict between the precise fragile self-confidence. It was essential that these assess-
and unambiguous nature of their training and the unpre- ments should concentrate on the positive aspects of the
dictability and imprecision of their everyday practice. clinician’s performance, she said.
She quoted an unnamed small animal practitioner who Meanwhile, the veterinary organisations should try to
had been qualified for 16 years. “Undergraduate training counter the impression held by some clients that veterinary
is black and white. Come out to the real world and it’s just medicine is an exact science. “Unadulterated scientific logic
grey. You struggle with things, and as you go through your can be almost as dangerous as the magic and myth that it
career, you realise that it never really was black and white, replaced,” she argued.
just it was easier to digest if it was presented that way.” All members of the profession should remember to exer-
As a self-selecting group of academic high achievers, vet cise the humility shown by their most celebrated colleague,
students will usually graduate with little experience of fail- Alf Wight – the man responsible for inspiring many of
ure. So, when things go wrong and a patient dies, this may them to choose a career in veterinary practice. “It’s a funny
come as a profound shock, she said. “Vets are no more able profession. It offers unparalleled opportunities for making
than any of us to render their world orderly and predict- a chump of yourself. It helps to be good at the job… but
able, but perhaps because of the knowledge, training and even if you’re a positive genius, humiliation and ridicule are
notions of attaining particular forms of idealised expertise lurking just around the corner,” he once said. VP
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Highlights for Congress 2019
What can delegates most look forward to drive day-to-day efficiencies, looking after physical health
and how to build a career by design. Plus, the congress is
to at the 2019 BSAVA Congress? proud to offer a crèche facility supporting working parents
E
to access high-quality CPD.
very inch of BSAVA Congress 2019 has been crafted
with delegates in mind. From the varied programme to Industry expertise
the largest small animal-focused exhibition in Europe, The congress exhibition is the only place to see the latest
the whole event is designed by a team of volunteer vets and products, innovations and services all focused on the needs
nurses. BSAVA President, Philip Lhermette, provides his top of the small animal vet and veterinary nurse. It’s also
picks for this year’s event. completely free to attend – so if you are a vet, veterinary
nurse or work in practice and don’t have time for lectures,
First-class CPD make sure you take advantage of booking a free exhibition
Alongside international speakers and experts, the pro- pass online.
gramme is underpinned by the current needs of the profes- The exhibition is also a fantastic location to access
sion, providing topical, clinically relevant and evidence-based relevant CPD from leading companies, and in an exciting
content within a first-class learning environment. development for April, a new lecture theatre will be built
Congress continually evolves and (among countless high- within the exhibition floor, meaning access to latest industry
lights) 2019 includes an “Advanced practitioner” stream, a insight has never been so easy.
new interview format in “Immunology” and state-of-the-art
lectures led by 2019 Bourgelat winner Mike Herrtage. There Work hard, play hard
are new themes running across many streams to ensure Not only is the education inspiring, but there is a full social
the content is delivered in an accessible format. Due to programme to help you unwind. The V19 Beach Party on
popular demand, the ophthalmology stream makes a return Saturday night is packed full of bands, buskers, comedy
in 2019, and the capacity of the incredibly well-received and food from around the world. Plus, head to the exhibition
cardiology sessions has been increased. for complimentary drinks every evening, catch Mamma Mia!
and Mamma Mia! Here We Go Again at “Movie Night”, enjoy
It’s about you a coastal cookout on Sunday and join us at the new Pres-
The new stream of non-clinical CPD, “Beyond the clinics”, ident’s Soirée on Friday evening at Birmingham Museum
received a fantastic reception in 2018 and BSAVA continues and Art Gallery.
to provide this holistic support with lectures including how
14Free-of-charge
Product Export
training for veterinarians,
funded by APHA
This offer is for a limited period only
Who is eligible?
Those who are registered as Official
Veterinarians (OVs) but don’t currently
hold the Official Controls Qualification
(Veterinary) - Product Exports
(OCQ(V) - PX):
Training will be provided free of charge in OCQ(V) - PX
as well as OCQ(V) - EX (Exports General) and/or
OCQ(V) - ES (Essential Skills) if not already held.*
Veterinarians who are not currently OVs but
wish to offer Product Export certification
services:
Free-of-charge registration with Improve International
and online training in OCQ(V) - ES, OCQ(V) - EX and
OCQ(V) - PX will be provided.
To apply, contact the APHA OV Team on
0208 026 1094
This offer is made as a direct result of the potential for new demand for certification
of animal products that may result if the UK leaves the EU without a deal.
Please note: the offer and access to any free training may
be withdrawn before this date if the UK agrees on a deal with
the EU that results in an implementation period or if the
available budget is reached.
* APHA will not provide free-of-charge access to revalidation training
for OVs whose OCQ(V) - ES and OCQ(V) - EX qualifications are due to
expire on 30th June 2019.
For more information about training and revalidation, please visit
www.improve-ov.com Veterinary Practice | March 2019 15BSAVA CONGRESS
Leading vet to receive Mike will deliver two lectures as part of the Bourgelat
2019 Bourgelat Award stream of four 45-minute lectures on Friday 5 April at the
Professor Mike Herrtage will 2019 congress:
receive the prestigious
Bourgelat Award from the ρρ Atypical hypoadrenocorticism
BSAVA at this year’s congress, ρρ Diagnosis of canine hyperadrenocorticism: is it always
in recognition of his enormous straightforward?
contribution to the development
of the veterinary profession and Additional lectures in the Bourgelat stream are:
particularly specialisation in the Award winner Mike Herrtage
UK and Europe. ρρ Imaging the adrenals (Raquel Salguero, Madrid)
As one of the world’s leading small animal medicine
specialists, Mike has been a co-author on more than ρρ Monitoring treatment in canine hyperadrenocorticism
100 scientific papers covering small animal medicine, (Ian Ramsey, Glasgow)
diagnostic imaging and neurology, and has written more
than 200 other publications. He continues to be an inspira- Mike has made a major contribution to veterinary research
tional teacher to generations of undergraduate and post- and scholarship by his investigations into metabolic and
graduate students. endocrine diseases such as diabetes mellitus, Cushing’s
At the same time, he has remained an active clinician, disease (hyperadrenocorticism), Addison’s disease (hy-
providing a referral service in small animal medicine and poadrenocorticism), Bedlington Terrier toxicosis, fucosido-
diagnostic imaging. Retiring this year as Dean of Cambridge sis and endocrine responses in critical illness.
Veterinary School, he holds qualifications in internal medi- He has held numerous prestigious positions in national
cine, diagnostic imaging and dermatology. and international veterinary organisations, including the
The Bourgelat Award – in honour of Claude Bourgelat, presidencies of the European College of Veterinary Internal
founder of the world’s first veterinary school in Lyon, Medicine, European Board of Veterinary Specialisation,
France, in 1761 – is presented annually by the BSAVA for European Society of Veterinary Endocrinology, British Vet-
outstanding international contributions to the field of small erinary Radiological Association and BSAVA. He also served
animal practice. It takes the form of BSAVA manuals and a as a member of the Council of the RCVS for over 20 years
financial award. and held many positions in the college’s committee.
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BSAVA CONGRESS
The social calendar
There’s a social event for every occasion at BSAVA Con-
gress 2019. Unwind, catch up and let your hair down after a
packed day of learning.
Movie Night
Thursday 4 April: Mamma Mia!
Friday 5 April: Mamma Mia! Here We Go Again
Hall 5, The ICC, 8pm, £7.50
Get your singing voices ready and escape to the Aegean on
Thursday and Friday evenings with Movie Night.
President’s Soirée
Friday 5 April
Birmingham Museum and Art Gallery
8 to 10.30pm, £65
Don’t miss a spectacular evening of food, entertainment and
networking hosted in the stunning Birmingham Museum
and Art Gallery. Celebrate everything we love about the Saturday night brings beach vibes to the congress with
profession with drinks on arrival and an exquisite selection a boatload of bands, comedy and culinary delights. Each
of bowl food along with entertainment from talented harpist ticket comes with two complimentary drinks.
Tori Handsley. The party will be headlined by Duke, who smashed their
performance at the congress three years ago and have only
V19 Beach Party got bigger and better. There will also be a silent disco and
Saturday 6 April, Hall 3, The ICC music from Frazer Lepford on the acoustic stage. For those
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Veterinary Practice | March 2019 19INNOVATION
Could a new app spark change in
the veterinary market?
The introduction of a first-of-its-kind SW We’re focusing on dermatology at launch; we know
that’s beautifully aligned with remote consultation, because
veterinary app for cat and dog owners it’s such a visual disease. When we were designing the app
may disrupt practice as we know it and the triage process, we collaborated with some Euro-
pean veterinary specialists and took part in a feasibility
study. It proved that remote consultation for dermatology
SARAH WARREN
cases was just as accurate in providing differential diagno-
Sarah is a veterinary dermatologist with 20 years of ses as it is in clinic.
clinical experience and is currently President of the
British Veterinary Dermatology Study Group. She’s
a key opinion leader for 10 leading pharmaceutical
companies and highly experienced in CPD provision
What are the main aims for the app?
and postgraduate teaching in dermatology. RD The idea behind the app is to try and bridge that gap
between Google and veterinary practice; almost everyone
PAUL HALLETT
goes to the internet to try to find out what a problem is
Paul has built a successful marketing agency where he
led global marketing campaigns for renowned brands.
first, unless it’s an absolute emergency. We’re trying to
He gained significant experience in med-tech, having engage people with the veterinary profession at the earliest
worked at board level with Ash Patel (ex-Babylon Health)
and Rich Mills (ex-Google).
possible stage.
ROBERT DAWSON PH We’re finding that more and more people are avoiding
Robert is a vet with 28 years of clinical experience. He the vets because of price. And that ultimately is an animal
spent 25 years in Highcroft vets, helping to make it
the largest veterinary group in the South West. Since
welfare issue. We feel that by providing this service, we’ll
co-founding Vet AI in January 2018, he has been fully have an impact on animal welfare.
immersed in exploring the potential of technology to
improve animals’ lives.
V “
eterinary Practice magazine spoke to co-founders
of Vet AI, Paul Hallett, Sarah Warren and Robert We’re trying to engage
“
Dawson, about the development of the new pet
health app, Joii. Launching in April 2019, the app is people with the veterinary
designed to give pet owners access to vets without having profession at the earliest
to visit a practice.
The app will be a cost-effective means to allow the
possible stage
many pets in the UK that are not registered with a vet
professional to receive advice and care. The team plans
to introduce artificial intelligence to detect and predict con-
ditions in pets and envisions positive changes to the work/ RD The bigger picture is that we’re going to be recording
life balance of veterinary professionals. the data we get from people entering problems into the
app and from the veterinary consultations in a structured
How will the app work? way. It will give us insights into pet diseases and health that
RD The app will give owners access to free veterinary haven’t been available before. Our ultimate goal is to have
advice in the form of a triage process that’s been written a system where we can increasingly predict disease and
by our own veterinary team in conjunction with vets from inform owners on how to prevent the disease rather than
pharmaceutical companies. waiting for it to come along.
The triage process will tell them whether they need to
go and see a vet, whether it’s a problem that they don’t If the triage is free for the client, how is the app financed?
really need to worry about, just keep an eye on, or if it’s PH We will sell products and do tele-consults straight
something that we can deal with in the form of a remote away. But the bigger picture is to work with the large
veterinary consult. If our triage process advises a remote pharmaceutical companies and help them reduce spends
consultation when the pet has a problem that requires a on drug trials and improve medication – things like that. I
visit to a veterinary practice, they will not be charged for think we’ll be able to leverage our data when it becomes
the remote consult. significant enough.
20Could a new app spark change in the veterinary market?
How much will it cost a
client for a remote
consultation?
RD It would cost about £20.
A complete tool kit for
vets, pets and pet owners
How does the app sit in
terms of veterinary regu-
lations and the definition of
“under his or her care”?
RD We’re working really
closely with the RCVS, who
are going through a process
of reviewing the guidelines of
remote prescribing. If we can
set out a framework which
controls it from an early
stage, we can make sure that
pet owners and vets
are protected. SW And behaviour is really suitable for remote consul-
The potential for somebody to come in from a larger tation. We’re planning to work with a behaviourist and
business outside the veterinary profession and do some- provide behavioural consultations.
thing similar in an unethical way is considerable. And I think
the Royal College are very aware of that. We would like it Are you expecting to have a relationship with practices
to come under the Practice Standards Scheme; if they want whereby if the vet diagnoses a condition that is easy to
to, we will help set up the guidelines around it to make manage, they will direct the client to the app?
sure that there are clinical notes that can be inspected, that RD First, we want to demonstrate that we’re creating a
we’re adhering to prescribing policies around antibiotic significant amount of traffic into practices: that we’re identi-
resistance and other areas and we can show that, where fying problems that maybe people wouldn’t have identified
appropriate, we’re sending people into practice. had they not had the remote consult. We would like to part-
ner with local practices; we wouldn’t charge them for send-
Do you think you will be able to prescribe in future? ing cases in, but would like to have a relationship where we
RD Yes; it’s just a question of when, really, and what can exchange clinical notes freely. Potentially, if the owner
product ranges. I don’t think remote prescribing would be prefers to carry on managing something remotely, they
suitable for any potentially abusable drugs. But I think it have that option to do that with us. We see ourselves devel-
certainly would be for parasiticides, for instance, and for oping a network of partner practices over the country.
things like anti-inflammatories for arthritis, and antibiotics,
although there could be some restrictions on the amount of Would your veterinary staff be working full time?
antibiotics that we prescribe. SW We’ll be employing a small number of full-time vets
at launch, and then taking on a pool of vets that can come
Will you be working with insurers? on board quickly, who will want to work with us part-time
RD We probably will work with an insurer, or several. For and combine that with their job in practice. It’s the same for
them, I think the most exciting thing about what we’re doing nurses. We’re planning on taking on three nurses at launch:
is potentially identifying predictive and preventative care two full-time, and one part-time. We’ve had a hugely enthu-
plans. It could make insurance much more affordable. siastic uptake from vets who want to improve their work/
life balance.
Which areas of practice do you think it will work well for,
and where do you think it could never work remotely? What are your longer-term goals?
RD [It will work for] low risk conditions, I think. Manage- RD We are committed to pet healthcare and our goal long
ment of long-term cases is another area, even if at some term is to go outside of the UK. The UK has got very good
point you have to have a work-up in practice. veterinary provision anyway. And pets, on the whole, are
Things that aren’t suitable include: anything that’s an looked after well here. In some parts of the developing
emergency; seizuring animals; a vomiting dog where you world, people have the same relationships between pets
need to palpate the abdomen. Some things: operations, and owners, but without access to the veterinary care.
X-rays, ultrasound scans, will never be available as a We’re going to be able to make it really affordable with the
remote consult. I think, over time, practices are going to app once the AI develops and is completely available to
deal with the high-level stuff, and more of the less urgent anybody with a mobile phone. Hopefully it will transform
things will be dealt with remotely. the lives of pets in large parts of the world. VP
Veterinary Practice | March 2019 21RCVS KNOWLEDGE
Blocking the pain of castration in
cats and dogs
The benefit of intratesticular blocks
in reducing pain in cats and dogs
undergoing orchiectomies depends on
the type of premedication used
environments or had the potential for bias. That being said,
I
n a clinical scenario where a pure µ-opioid agonist is not the pattern was reproduced across the studies.
used (ie a partial µ-opioid like buprenorphine is adminis-
tered instead), an intratesticular block may be indicated. Other considerations for the vet
However, where a pure µ-opioid is used, an adjunctive The clinical questions of the two Knowledge Summaries
intratesticular block may not provide significant benefit. specifically targeted intratesticular blocks as an adjunctive
analgesic. If the questions were modified to look at other
A clear pattern forms of analgesia, such as isoflurane, propofol and rescue
Analysis of seven studies presented across two Knowledge analgesic sparing effect, the conclusions may be different.
Summaries in Veterinary Evidence – one for cats and one Similarly, the majority of studies only used lidocaine as the
for dogs – initially demonstrated extreme inconsistency in
the effect of intratesticular blocks on post-operative pain
“
scores. However, when the study samples were considered
separately by the type of premedication used, a clearer The most significant
pattern emerged:
For dogs, in studies that used pure µ-opioid agonists,
factor in the reduction of
there was less significance between control and intrates- post-operative pain, in
either species, appears
“
ticular block groups in post-operative pain scores. In all
studies where a pure µ-opioid agonist was not used, there
was clinical significance in the use of intratesticular blocks to be the analgesic used
(to favourable effect).
For cats, in the study that used a pure µ-opioid agonist,
perioperatively
there was marked improvement of the pure µ group over
intratesticular groups (and epidural groups) in pain scores.
As such, the most significant factor in the reduction of intratesticular block, with the alternative bupivacaine rarely
post-operative pain, in either species, appears to be the utilised. Only one study utilised pure µ-opioid premedication
analgesic used perioperatively. It must be noted, however, and bupivacaine but it had positive outcomes, so this is an
that much of the available literature was based on small- area for further study. However, there are concerns about
scale study populations, included non-standard clinical bupivacaine toxicity, while lidocaine led to no significantly
aversive events in any of the studies.
Lidocaine is relatively inexpensive and is easy to adminis-
ter. Although it may not be necessary to use it as an adjunc-
tive analgesic to premedication with a pure µ-opioid agonist,
in light of the low cost and minimal risk, an argument could
be made that it is still worthwhile to administer in most
clinical scenarios.
VP
The full Knowledge Summary for dogs can be viewed at:
veterinaryevidence.org/index.php/ve/article/view/206
and for cats, at:
veterinaryevidence.org/index.php/ve/article/view/160
Authors: Erik Fausak, Elizabeth Rodriguez, Anna
Elizabeth Simle, Netwarat Merman, Dakota Cook
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